Four more drugs you should avoid

By Dr. Ronald Hoffman

I recently completed a series entitled 12 Drugs You Should Never Take that generated a lot of buzz on the internet and via social media. No sooner had I completed it that I realized there were some additional great candidates for that dubious distinction. So here are four more drugs that should be outed:

1)Zetia: Taken alone or combined with statins (as in Vitorin, a combo drug of Zetia and Zocor) Zetia is a cholesterol-lowering drug with doubtful efficacy. It is often given when statins alone fail to bring patients to "goal" LDL cholesterol. Zetia works differently than statins, merely preventing the absorption of cholesterol from the intestinal tract. First introduced in 2004, reports emerged by 2007 that risks of Zetia (which include liver damage and pancreatitis) were not appropriately disclosed by the manufacturers Merck and Schering Plough.

And, in a 2009 study, Zetia was trounced by good old-fashioned niacin as a way of getting cholesterol down-with the added benefit of reducing plaque and heart attacks. But most decisively, despite the fact that Zetia added to a statin admittedly boosts cholesterol-lowering, the ENHANCE study in 2008 found that the Zetia/statin combo did NOT augment the statin's ability to protect carotid arteries. In fact, patients who took a statin plus Zetia had slightly MORE plaque than those who took a statin alone.

The take home message is that cholesterol-lowering is not a panacea for heart-disease prevention; indeed, it's suspected by many experts that the benefits of statins lie not in their cholesterol-lowering effects, but rather, that they are potent anti-inflammatories -- like expensive versions of aspirin. Zetia has none of these anti-inflammatory properties. Since doubt has been cast on the importance of radical lowering of "bad" cholesterol to mid-double digits, Zetia and Vitorin have taken a hit in popularity.

BOTTOM LINE: If you're concerned about heart disease prevention, forego Zetia and Vitorin, which might fix your numbers but give you a false sense of security. Instead, follow a low-carb, anti-inflammatory diet, exercise, and take supplements like olive leaf extract, resveratrol, curcumin, fish oil, vitamin K2, magnesium, Coenzyme Q10 or Ubiquinol, and aged garlic extract.

2)Tricor. Another drug for high lipids, Tricor specifically targets elevated triglycerides. Indirectly, it also lowers cholesterol, because 1/5 of triglycerides are channeled into bad VLDL cholesterol. In other words, shaving 200 points off your triglycerides will automatically lower your cholesterol by 40 points without dropping the good HDL cholesterol, resulting in a much-improved lipid "ratio".

But Tricor spells trouble for two reasons. First, it lowers triglycerides artificially, correcting numbers on your blood test while not having any impact on the two major problems that accompany high triglycerides: metabolic syndrome and fatty liver. These can only be corrected when patients undertake proper diet and lifestyle change. Patients taking Tricor are dis-incentivized by a superficial fix that leaves their primary risks for other disease and other serious health problems unaddressed.

To make matters worse, Tricor comes with a host of side effects: Liver problems, pancreatitis, digestive problems, and gallstones.

BOTTOM LINE: I've never had to use Tricor with patients to lower triglycerides because they are so responsive to a low-carb diet, exercise, and high-dose fish oil supplementation. Patients are amazed that when they stop guzzling fruit juice and sugar-laced bottled teas, skip the pasta, "low-fat" yogurt, bread and mashed potatoes, and forego desserts, and add healthy portions of grass-fed organic meats, butter, coconut oil and nuts, their triglycerides melt away as if by magic! Three capsules of high-potency fish oil twice daily will complete the job and usually brings triglycerides from the mid-three digits into safe, two-digit territory.

3) Zyprexa. A powerful anti-psychotic med, Zyprexa was often inappropriately prescribed to sedate agitated elderly patients with dementia. Gorking patients out with chemical straight-jackets to keep them in line is one of the worst forms of elder abuse, yet that is precisely what the manufacturers of Zyprexa encouraged doctors and nursing home administrators to do. As a result they were slapped with a record 1.415 billion dollar fine for false promotion.

Yet a report by the Health and Human Services Administration issued in May of 2011 found that 83 percent of Medicare claims for antipsychotics were for residents with dementia, the condition specifically warned against in Zyprexa's labeling. Fourteen percent of all nursing home residents, nearly 305,000 patients, were prescribed antipsychotics.

Worst of all, even for younger, non-demented mental patients for whom Zyprexa is prescribed "appropriately," there is an unacceptably high risk of profound weight gain and diabetes. Consumers of meds like Zyprexa often develop an inordinate craving for sweets.

BOTTOM LINE: The tragedy of over-prescribing Zyprexa to the elderly epitomizes all that's wrong with our care paradigm for the aged. Warehousing them in nursing homes and sedating them with powerful drugs is a national shame.

4)Accutane. An acne drug that was once frequently and cavalierly prescribed to teenagers with problem skin, Accutane is the "poster boy" for a drug once thought safe and effective, but whose dire side effects only emerged too late to prevent serious, long-lasting damage to thousands.

Pulled from routine usage in 2009 when a link to ulcerative colitis was definitively established, Accutane is now available only from dermatologists on a very restricted basis.

I've seen patients who took Accutane develop severe, puzzling body-wide inflammation. It can cause depression, and was the subject of a Congressional hearing when the son of a US representative who was taking it committed suicide. And it's so toxic to the developing fetus, it must only be prescribed to women under the most strict contraception protocols.

BOTTOM LINE: Effective as Accutane was for some acne sufferers, it's not worth the risk of serious side effects. There are so many natural ways to treat acne involving diet modification, use of helpful supplements like olive leaf extract, pantotheine, l-carnitine, niacinamide, skin applications of manuka oil cream and extra virgin coconut oil (see my article Everything You Wanted to Know About Natural Therapies for Acne ) that I think Accutane should be relegated to Pandora?s box forever.